Diabetes and COVID-19

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RE: Can RN CDCES provide DSMT via telehealth?

  • 1.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-15-2020 16:16
    ​​ Patients with Diabetes benefit from a multidisciplinary team approach for education and treatment.  At this difficult time, only RDs are to charge the education provided via telemedicine. I hope this rule is revised soon but meanwhile be aware that RD, CDCES are prepared and able to provide Diabetes Education in all self-care behaviors , not only in "diet" as mentioned above.

    Please refer to the Standards of Practice and Standards of Professional Performance for RDNs in Diabetes Care, https://jandonline.org/article/S2212-2672(18)30303-4/pdf, which states on page 939:

    "In specific instances, the practice of some RDNs has evolved to include care beyond diabetes MNT. In accordance with demonstrated competence and organization-approved protocols, some RDNs now provide instruction for self-monitoring blood glucose, insulin administration, adjusting diabetes medication, as well as provide training on CSII and CGM devices. It is important to note that neither the CDE nor BC-ADM credential authorizes an individual to perform tasks outside of his or her professional scope of practice, but an RDN, after competency is demonstrated, can teach a patient/ client to self-administer his or her own insulin injections or perform an invasive procedure and adjust medications when using provider or organization-approved protocols."




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    Valeria Rezende, MS,RDN,CDCES
    Cumming GA
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  • 2.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-16-2020 13:21
    Does this statement bother anyone else besides me?  Why shouldn't an RN CDCES be given the same ability to to provide DSME via telehealth or in person and be able to charge for these visits similarly as an RD or RDN?  The clinical and educational background of an RN, which now includes nutrition training, should be sufficient to prove "competency."  With diabetes so rampant, expanding the scope and role of the RN CDCES should be a consideration by the ADA and all boards of licensing and credentialing.

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    Debbie Erlandson BS, MSC, CDE
    Cigna
    Atlantic City NJ
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  • 3.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-16-2020 13:26
    Does this statement bother anyone else besides me?  Why shouldn't an RN CDCES be given the same ability to to provide DSME via telehealth or in person and be able to charge for these visits similarly as an RD or RDN?  The clinical and educational background of an RN, which now includes nutrition training, should be sufficient to prove "competency."  With diabetes so rampant, expanding the scope and role of the RN CDCES should be a consideration by the ADA and all boards of licensing and credentialing.

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    Debbie Erlandson BS, MSC, CDE
    Cigna
    Atlantic City NJ
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  • 4.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-17-2020 08:15
    I agree with Debbie and yes it bothers me as well.  I took the extra steps to be board certified and like me, many others are credentialed to provide the services as specified by ADA/ AADE.
    So, donot understand why it is differentiated at this time.​

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    Shesha Desai
    RWJ UNIV HOSPITAL HAM
    Hamilton NJ
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  • 5.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-17-2020 12:51
    Yes!!  It is Ridiculous. Does anyone know if ADA or AADE are working on this?

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    Martha Mitchell Funnell, MS, RN, CDE, FAAN
    Emeritus Research Scientist
    Department of Learning Health Sciences
    University of Michigan Medical School
    230 Victor Vaughan Bldg, SPC 2054
    1111 East Catherine Street
    Ann Arbor, MI 48109-2054
    (734) 358-3196
    Fax (734) 936-1641
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  • 6.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-17-2020 17:07

    I reached out and got this response and permission to share. Both ADSCE and ADA have been working for the past month to get this fixed. 


    Both ADCES  and the ADA urge CMS to allow RNs and pharmacists to furnish DSMT via telehealth during the COVID-19 pandemic. (3/17/20)

    ADCES, ADA, and the Endocrine Society submitted a request to CMS urging action and clarification around Medicare telehealth requirements for DSMT during the COVID-19 pandemic. (3/20/20)

    ADCES discussed the role of the diabetes care and education specialist and addresses Medicare challenges in letter to the National Clinical Care Commission. 

    Take action now and share your story here: https://www.diabeteseducator.org/advocacy/adces-legislative-action-center#/8

     



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    Martha Mitchell Funnell, MS, RN, CDE, FAAN
    Emeritus Research Scientist
    Department of Learning Health Sciences
    University of Michigan Medical School
    230 Victor Vaughan Bldg, SPC 2054
    1111 East Catherine Street
    Ann Arbor, MI 48109-2054
    (734) 358-3196
    Fax (734) 936-1641
    ------------------------------



  • 7.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-18-2020 12:18
    CMS published new guidance piece 4/17  in the MLN Newsletter on DSMT billing in FQHC
    MLN Newsletter 4/17

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    Michele Chynoweth RD, CDE
    BAKERSFIELD CA
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  • 8.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-18-2020 12:26
    All -
    Within this discussion it's important to understand the origins of why RD/RDNs can bill for MNT for diabetes care (and ESRD) as well as to deliver DSMES/T within the standards and within a program. It comes down to one simple general point - if a Medicare provider is approved to bill/be reimbursed for 1 Medicare service (e.g., MNT in the case of RD/RDNs), they can bill for another Medicare service (e.g., DSMES/T.) This decision is NOT about competencies. It's about Medicare rulemaking. Yes, this should change. I'm aware that ADCES is working diligently to change this (hopefully working with ADA to achieve the same). To learn more listen to ADCES' director of advocacy's ADCES Podcast (The Huddle): https://www.diabeteseducator.org/news/adces-podcasts (look for Update from Capitol Hill with Kate Thomas).

    Hope this is helpful.
    Hope Warshaw

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    Hope Warshaw RD, CDE
    ASHEVILLE NC
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  • 9.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-19-2020 09:15
    All -
    Within this discussion it's important to understand the origins of why RD/RDNs can bill for MNT for diabetes care (and ESRD) as well as to deliver DSMES/T within the standards and within a program. It comes down to one simple general point - if a Medicare provider is approved to bill/be reimbursed for 1 Medicare service (e.g., MNT in the case of RD/RDNs), they can bill for another Medicare service (e.g., DSMES/T.) This decision is NOT about competencies. It's about Medicare rulemaking. Yes, this should change. I'm aware that ADCES is working diligently to change this (hopefully working with ADA to achieve the same). To learn more listen to ADCES' director of advocacy's ADCES Podcast (The Huddle): https://www.diabeteseducator.org/news/adces-podcasts (look for Update from Capitol Hill with Kate Thomas).

    Hope this is helpful.
    Hope Warshaw

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    Hope Warshaw RD, CDE
    ASHEVILLE NC
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  • 10.  RE: Can RN CDCES provide DSMT via telehealth?

    Past ADA Officer
    Posted 04-19-2020 21:30

    Yes, both ADA and ADCES are very involved in getting RNs and RPhs approved!

     

    Margaret (Maggie) Powers PhD, RD, CDE

    Nutrition Practice and Evaluation | HealthPartners

    Mail Stop MS 61N07C | 3800 Park Nicollet Blvd  |  Minneapolis, MN | 55416

    (952) 993-2793  |  margaret.powers@parknicollet.com

     

     






  • 11.  RE: Can RN CDCES provide DSMT via telehealth?

    Posted 04-17-2020 16:06
    Yes, it bothers me too.  I am in full agreement with Debbie.

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    Saleh Adi, MD
    San Francisco, CA
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